LIBRARY OF CONGRESS. ?l 

, _____ -»*1i 



^SA, 



^7? 



UNITED STATES OF AMERICA, 



RESEARCHES 



ON THE 



3IEDICAL PROPERTIES AND APPLICATIONS 



OF 



NITROUS OXIDE, 



PROTOXIDE OF NITROGEN, 



OR LAUGHING GAS. 



V BY 

GEO. J! ZIEGLER, M. D., 

PHYSICIAN TO THE PHILADELPHIA HOSPITAL. MEMBER OF THE AMERICAN MEDICAL 

ASSOCIATION, MEMBER OF THE ACADEMY OF NATURAL SCIENCES 

OF PHILADELPHIA, ETC. ETC. 



Kevised and Kepnblished from the Med. and Surg, Eeporter. 



PHILADELPHIA : 

J. B. LIPPINCOTT & CO. 

186 5. 



Entered, according to Act of Congress, in the year 1865, by 

GEORGE J. ZIEGLER, M.D., 

In the Clerk's Office of the District Court of the United States for the Eastern 
District of Pennsylvania. 



PREFACE. 



In the followiDg pages, with some general reflections on 
collateral subjects, I have endeavored to present a condensed 
summary of the medical properties and applications of nitrous 
oxide as determined by a series of observations from time to 
time during a period of about sixteen years. These are neces- 
sarily incomplete and to a certain extent inconclusive, yet 
hoped they are sufficiently impressive to attract attention and 
induce more enlarged effort to determine the sanitive value of 
this remarkable agent and extend its sphere of usefulness in 
the preservation of life, promotion of health, and the relief of 
disease. Hence a close scrutiny of the facts presented and 
ideas advanced, and a liberal examination of the sanitive qual- 
ities of protoxide of nitrogen are particularly invited, believ- 
ing that a more extended and thorough investigation of its 
properties will not only confirm the statements herein made 
and enable physicians to attain a greater degree of success 
in the amelioration of the ills of life, but will otherwise 
result in great good to the medical profession and humanity 
at large. G. J. Z. 

Philadelphia, July 15th, 1865. 



MEDICAL PROPERTIES AND APPLICATIONS 



OP 



PROTOXIDE OF NITROGEN, 

NITEOUS OXIDE, OR LAUGHING GAS. 



INTRODUCTORY. 



Notwithstanding the present activity in the search 
for new remedies and the manifest desire to discover 
such as are both conservative in character and efficient 
in action, attention appears to be still too exclusively 
concentrated upon those agents which are more purely 
medicinal in their nature rather than upon such as have 
a direct physiological compatibility with the vital organ- 
ism. The undue tendency in this direction has of recent 
years, however, been materially modified in consequence 
of a better appreciation of the general laws and cor- 
relations of physiology, pathology, hygiene, and thera- 
peutics. 

With this increased knowledge of medical science a 
more philosophical conception of the inherent nature 
and biological attributes of remedies has been acquired 
whereby it has become apparent that those agents which 
either subserve the immediate purpose of supplying 

1* (5) 



6 MEDICAL PROPERTIES AND APPLICATIONS OF 

elements of nutrition to, or in exerting a direct influ- 
ence upon the functions of the living economy, or both 
combined, are, in the main, the most efficient and reli- 
able for therapeutic purposes.* Hence, notwithstanding 
apparent exceptions, it may be regarded as a general 
truism that the greater the physiological compatibility 
of medicinal agents the greater their remedial efficiency. 

But, as just intimated, this vital compatibility is of a 
compound character, being both of a material and 
dynamic nature, and manifested either singly or in con- 
junction with each other. Thus, for instance, such 
substances as iron, lime, potash, and soda, have an im- 
mediate material connection with the animal organism ; 
while, on the other hand, quinia, strychnia, and others 
of the same class have a somewhat direct dynamic rela- 
tion thereto ; light, heat, electricity, and all influences 
of a psychical nature being still more purely dynamic in 
their properties and effects; whereas phosphorus and 
some other agents of a similar character, subserve both 
a material and dynamic purpose in the processes of life. 

TVith a view, therefore, to concentrate attention upon 
a remarkable agent of the kind last indicated, as well 
as to intensify thought upon the general subject of the 
physiological compatibility of remedies, I propose in 
this paper to present some general observations upon 
the medical properties and applications of nitrous oxide, 



* Many of them in fact, acting thus in the double capacity of 
materia alimentaria and materia medica. 



PROTOXIDE OF NITROGEN, ETC. 



referring those interested for a more extended notice 
thereof to my former publications respectively entitled 
Zoo-adynamia ; Toxicological, but which should have 
been Antidotal Applications of Nitrous Oxide,* Bos- 
ton Med. and Surg. Jour., vol. xlvi. No. 14; Anaema- 
tosis, its consequences, prevention, and treatment, Ibid., 
vol. xlvi. Nos. 22, 23 ; Experimental Investigations on 
the Antidotal and Revivifying Properties of Nitrous 
Oxide, Ibid., xlvii. No. 19; Haematosis, its natural and 
artificial induction, Ibid., xlix. Nos. 3, 4, 5, 6; Glucosis, 
Ibid., vol. L. No. 11 ; Nitrous Oxide, its properties and 
applications, Dental Cosmos, vol. i. No. 12; Nitrous 
Oxide, its medical properties and applications, Boston 
Med. and Surg. Jour., vol. lxvii. No. 25; and Amer. 
Med. Times, vol. vi. No. 6 ; Nitrous Oxide in Asphyxia, 
Med. and Surg. Reporter, vol. ix. Nos. 21, 22; Nitrous 
Oxide as an Anaesthetic, Dental Cosmos, vol. v. No. 5. 
In the effort, therefore, to render this exposition as 
succinct, comprehensive, and practical as possible, I will 
treat of the subject under the several heads, of first, the 
chemical constitution, properties, and correlations of 
protoxide of nitrogen ; second, its physiological influ- 
ences and hygienic uses; third, its medicinal properties 
and applications, therapeutic, revivifying, antidotal, and 
anaesthetic; fourth, its preparation and combinations; 
and, fifth, its modes of administration and dose. 

* Several typographical errors occur in this and other papers, 
partly from not having had an opportunity to see the proof. 



MEDICAL PROPERTIES AND APPLICATIONS OF 



I. Chemical Constitution, Properties, and Correlations of 
Nitrons Oxide. 

In the first place, with regard to its constitution, 
nitrous oxide is a chemical compound in equivalent 
proportions of the two gaseous elements nitrogen and 
oxygen, hence designated in accordance with the usual 
nomenclature and notation protoxide of nitrogen, with 
the symbol NO, and equivalent numbers 22,00. It is 
an elastic, colorless gas of the sp. gr. 1,521, having a 
somewhat faint, but agreeable odor, and sweetish taste, 
which it imparts to water. Under a pressure of about 
30 atmospheres at 0°, or 50 atmospheres at a tem- 
perature of 45° F., this gas condenses into a colorless 
transparent liquid, and from between 100° to 150° 
below zero solidifies into a beautiful clear crystalline 
body. The evaporation of this solid protoxide of ni- 
trogen produces a degree of cold far greater than that 
of carbonic acid in vacuo, yet as it evaporates slowly 
it does not like the latter, solidify by its own vaporiza- 
tion. * 

* Some recent observations upon this subject in confirmation 
of the above, are thus detailed in a late number of the Med. 
Times and Gazette, from the Rev. Med. 

"Liquefaction of Laughing Gas. — One of the most interesting 
objects at a recent soiree at the Paris Observatory consisted in 
the exhibition of the liquefaction of laughing gas, the protoxide 
of nitrogen, by M. Bianchi. This took place at zero Centigrade 
under a pressure of thirty atmospheres, the fluid issuing in a 



PROTOXIDE OF NITROGEN, ETC. V 

The fact that protoxide of nitrogen is capable of 
being thus somewhat readily reduced to a liquid and 
solid state is now of very little more than scientific in- 
terest; but the time is probably not very far distant 
when it will become of the utmost practical value in 
view of the many and highly important medical pur- 
poses to which this remarkable agent is applicable. 

In composition nitrous oxide differs from all other 
chemical bodies, although identical in constitution in 
the main, with atmospheric air, varying therefrom, how- 
ever, both in the proportion of its constituent elements, 
and in the character of their association. Thus while 
nitrous oxide contains about one-third of oxygen to 
two-thirds of nitrogen, atmospheric air has only about 
one-fifth of the former to four-fifths of the latter. 
Moreover, in nitrous oxide the respective elements 
nitrogen and oxygen, are in chemical combination with 



small jet from a strong metallic reservoir. Received in a glass 
tube, it retained its liquid condition by reason of the depression 
of temperature produced by evaporation, so that mercury being 
introduced solidified, and could be hammered like lead. Simul- 
taneously, a body in a state of ignition, plunged into the atmos- 
phere of the liquid, in which the mercury froze, burnt with a 
brilliant light. On pouring the protoxide into a small platinum 
capsule heated to redness, the liquid was found to retain all its 
properties while assuming the spheroidal state, and was still 
able to freeze mercury contained in little glass ampullae . Fi- 
nally, the liquid protoxide became solidified uuder the recipient 
of an air-pump, the temperature being reduced to 120° below 
zero Centigrade — the most intense cold yet obtained."! 



10 MEDICAL PROPERTIES AND APPLICATIONS OF 

each other, whereas in atmospheric air they are in but 
simple mechanical association without any apparent 
chemical union whatever. Nevertheless, though thus 
differing in the relative proportion and character of 
association of these constitutional elements, protoxide 
of nitrogen and atmospheric air are similar in their 
general properties and relations, varying more in the 
degree, perhaps, than in the nature of their affinitive 
reactions and physiological effects. 

Besides atmospheric air, nitrous oxide is closely cor- 
related with oxygen, to which indeed it is so directly 
identified as to encourage the belief that all its active 
properties as well as those of its congener — atmospheric 
air — depend exclusively upon this one element, but that 
such is not the fact we expect to make evident here- 
after, notwithstanding the apparent similarity through- 
out of these respective agents, for in most of their 
prominent features they resemble each other so strik- 
ingly as to give rise to the impression of their inter- 
dependence upon one and the same substance just men- 
tioned. This general similitude is especially manifest 
in the chemical and vital reactions, for like atmospheric 
air and oxygen, protoxide of nitrogen is an active sup- 
porter of combustion and of life, though in these re- 
spects it is in some measure more nearly allied to the 
latter than the former, from the greater relative propor- 
tion of this important element as well as in consequence, 
doubtless, of the peculiar combination of its constituents. 



PROTOXIDE OF NITROGEN, ETC. 11 

While, however, there is thus an intimate mechanical, 
chemical, and physiological correlation between these 
respective gaseous bodies, there are some specific differ- 
ences in nature and properties manifested more partic- 
ularly in their vital influences, which render them ap- 
propriate for distinct though somewhat similar medical 
purposes. But as a notice of these more in detail 
involves the consideration of another branch of the 
subject, I will proceed to their further discussion in 
that connection. 

II. Physiological Influences and Hygienic Uses of Protoxide 

of Nitrogen. 

1. The physiological influences of nitrous oxide are 
of a peculiar and striking character, for though like 
some other agents it exerts a very energetic and de- 
cidedly stimulant action upon the animal economy, yet 
this is in general so entirely distiuct from all other ex- 
citants as to be quite unique. 

The effects of protoxide of nitrogen upon the human 
system vary in proportion to the quantity appropriated 
and the particular susceptibilities or conditions of indi- 
vidual organisms, passing from a gentle acceleration of 
all the functions of the body to a high degree of physi- 
cal excitement and mental exhilaration amounting in 
the extreme to an intensely pleasurable delirium or 
ecstacy which may indeed become so pure and exquisite 
as to absorb the consciousness of existence itself. 



12 MEDICAL PROPERTIES AND APPLICATIONS OF 

When exhibited in moderate quantities, nitrous oxide 
usually produces a mild and very pleasant thrilling 
sensation rapidly extending over the whole system, at- 
tended with forcible and prolonged respiratory efforts, 
and a strong disposition to laughter and muscular mo- 
tion, which often becomes so irresistible as to be in- 
voluntary. If taken freely, these agreeable sensations 
are greatly enhanced, accompanied with a remarkable 
buoyancy of spirits, boisterous gayety, activity of imag- 
ination, rapid flow of vivid ideas and brilliancy of 
mental conceptions of the most sublime character, the 
direction of thought being influenced in some measure, 
by the dominant idea at the commencement of its action, 
hence sometimes followed by other than hilarious mani- 
festations. Used largely, this state of excitement rapidly 
passes into one of rapturous enjoyment, entranced tran- 
quillity, and complete repose with entire insensibility 
and unconsciousness, during the existence of which the 
mind becomes temporarily oblivious to all impressions, 
even of an ordinarily painful nature. The primary 
stage of sur-excitation with its concomitants, anaesthesia 
and trance, is usually, however, of brief duration, term- 
inating rather suddenly, yet leaving generally a sense of 
permanent invigoration similar to that resulting from a 
free exposure to fresh atmospheric air, not being fol- 
lowed with any reactive languor or depression so com- 
mon with ordinary stimulants. 

Besides its general physiological effects, nitrous oxide 



PROTOXIDE OF NITROGEN, ETC. 13 

has also special tendencies to certain parts of the body, 
particularly the blood, brain, nervous system, and genito- 
urinary organs, being very efficient in preserving the 
healthy integrity of such portions of the economy and 
in promoting the functions more immediately connected 
therewith. 

Respecting the modus operandi of protoxide of nitro- 
gen, there is very little doubt but what it exerts both a 
material and dynamic influence upon the animal or- 
ganism through each of its constituents singly and 
conjointly, yet, notwithstanding the peculiar character 
of its biological effects seems to conclusively prove that 
they are dependent upon its constitutional elements in 
their separate as well as combined state, it is, by some, 
thought to act through one exclusively. Nevertheless, 
though it is obvious that much of its potency is derived 
from the oxygen, it is demonstrable that it alone is not 
sufficiently energetic to account for all of the phenomena 
resulting from the operation of nitrous oxide upon the 
human system, some of these being so entirely distinct 
from the usual action of that element as to justify the 
conclusion of the additional influence of the nitrogen 
for their production. 

This is especially the case in its marked tendency to, 
and specialty of action on particular parts of the sys- 
tem, as for instance the genito- urinary organs, wherein 
it differs greatly from the former, for it not only increases 
the excitability of these organs, but improves the quality 

2 



ldL MEDICAL PROPERTIES AND APPLICATIONS 01 

ell as regulates the quantity of secretion therefrom, 
both by directly augmenting their power and pi 
the normal genesis and elimination of their educts. The 
correctness of this view is more clearly apparent from 
the peculiarity of the effects of nitrous oxide upon the 
renal secretion in the enlarged production of the nitro- 
genous ingredients — especially urea — of that fluid, to 
h it gives rise in a remarkable degree. It is most 
probable, therefore, that the physiological action of 
protoxide of nitrogen is of a compound character, from 
the operation of both its constituents — nitrogen aud oxy- 
gen — in their associated and single e the affinitive 
reactions between them and the general components of 
the organism being more decidedly. manifested in conse- 
quence of its undergoing decomposition, and the pre- 
sentation of these elements in a nascent state within the 
body. The chemico-organic and bio-dynamic influence 
of nitrous oxide is hence so much the greater from the 
presence of its constituents in an actively divided s 
the nascent condition affording the most favorable op- 
portunity for chemical reaction, molecular nutrition, 
organic metamorphosis, dynamic manifestation, and 
vital development. 

Protoxide of nitrogen is thus altogether unique in 
being a rapidly diffusible, potent, general, and permanent 
stimulant, intensifying all the vital actions, supplying 
elements of nutrition, exerting both a material and 
dynamic influence upon the animal economy, aud in 



PROTOXIDE OF NITROGEN, ETC. 15 



having a direct physiological compatibility therewith 
both functional and organic. 

Hence, with respect to the predominant characteristics 
of protoxide of nitrogen it is truly sui generis, though 
closely allied in chemical constitution, material proper- 
ties, and sanitive effects with atmospheric air, which 
may be regarded, in fact, as its natural prototype, dif- 
fering therefrom apparently more in the proportion of 
its constituent elements — nitrogen and oxygen — and in 
the manner of their association, than in any other es- 
sential respect, although its action upon the vital 
economy is more energetic, definite, and perceptible, 
than that of the latter, varying rather in the degree, per- 
haps, than in the nature of its physiological influence. 
Still, though there is thus a very strong analogy be- 
tween protoxide of nitrogen and atmospheric air, yet 
in their relative effects upon the animal organism they 
vary somewhat materially, as there is a striking differ- 
ence in the ratio or measure as well as in the kind of 
action thereupon, for the biological effects of the former 
are not only more intense, concentrated, and manifest, 
but also more decidedly stimulant than those of the lat- 
ter, though they are likewise of a general, very bland, 
and highly invigorating character. 

While, therefore, there is thus a very intimate cor- 
relation between these two compound gaseous bodies — 
nitrous oxide and atmospheric air-^yet each one has 
special peculiarities of its own, of such a marked 



16 MEDICAL PROPERTIES AND APPLICATIONS OF 

character indeed, as to make them appear quite distinct 
and render them useful for diverse as well as similar 
purposes. 

2. The hygienic uses of protoxide of nitrogen are 
varied and important. The nature of these is indicated 
by the character of its physiological influences in ac- 
celerating the normal processes of life, yet for practical 
purposes a more specific notice thereof may not be 
unprofitable. 

In brief then, through its constituent elements and 
dynamic properties, nitrous oxide exerts a powerful 
influence in both supplying essential matter for organ- 
ization, and in promoting the general molecular, cell, 
nutrient, reproductive and dynamic operations of the 
animal economy, those of the vegetal, animal, and 
psychical life inclusive. It is thus indeed, remarkably 
active and potent in promoting the various functions of 
digestion, absorption, circulation — both general and 
capillary — aeration or arterialization, hsematosis, calori- 
fication, assimilation, disintegration, depuration, secre- 
tion, excretion, muscular and general contractility, 
innervation, and intellection ; and likewise, those of the 
reproductive system. Hence, for the preservation of 
the healthy integrity of the body and the regulation 
as well as invigoration of all the important functions 
of life, this agent may, caeteris paribus, be always em- 
ployed with advantage. This concise but comprehen- 
sive outline of the sanitive effects and applications of 



PROTOXIDE OF NITROGEN, ETC. If 

protoxide of nitrogen will suffice to show that in an 
hygienic point of view it is both unique and invalu- 
able. 

It would seem, a priori, that an agent which exerts 
such a potent material and dynamic influence over the 
animal organism in maintaining its normal status, 
should necessarily be very efficient in correcting as well 
as in preventing abnormal action, and both observation 
and experience have shown the correctness of this con- 
clusion. It has thus been demonstrated, both a priori 
and a posteriori, that nitrous oxide is of pre-eminent 
importance in restoring as well as in preserving health. 

Of these remedial powers and applications I will now 
speak more specifically. 



III. Medicinal Properties and Applications of Protoxide of 

Nitrogen. 

As this branch of the subject — which, like the pre- 
ceding, involves principles and practice of a perfectly 
novel yet eminently practical character — is so very ex- 
tensive as to require for its proper elucidation more 
time and space than can now be given it, I shall not 
attempt to enter much into detail, but merely endeavor 
to present a very general sketch of the prominent 
points of interest, leaving more specific observations 
for some future period. With a view, therefore, to thus 
exhibit a somewhat condensed and systematic summary 

2* 



18 MEDICAL PROPERTIES AND APPLICATIONS OF 

of the medicinal relations of nitrous oxide, I will, as 
before mentioned, treat of it in the several aspects of 
its therapeutical, revivifying, antidotal, and anaesthetic 
influences and uses. 

1. In a therapeutic as well as in an hygienic point of 
view, nitrous oxide is of extraordinary interest and 
value. Its practical applications for the removal as 
well as the prevention of disease are numerous and 
diversified. In fact, in these respects, the protoxide of 
nitrogen is not surpassed, if equalled by any known 
sanitive agent outside of those included in the materia 
alimentaria. It is indeed sui generis, as in conse- 
quence of its peculiar chemical constitution and prop- 
erties, its specialty and potency of physiological action, 
its extensive range and variety of sanitive application 
— hygienic, therapeutic, revivifying, antidotal, and 
anaesthetic — it differs greatly from, and is superior to 
the best and most powerful of known remedies. Xitrous 
oxide is thus unique in its physiological and sanitive 
influences as well as in its chemical constitution and 
properties ; for, though analogous in the extent and 
variety of its therapeutic uses, to some of the most 
active medicinal substances, such as iron, quassia, 
strychnia, quinia, mercury, etc., it is far superior to 
them in the greater range and diversity of remedial 
application as well as in the general character and 
special peculiarities of its effects upon the animal 
organism. Indeed, from my present knowledge upon 



PROTOXIDE OF NITROGEN, ETC. 19 

the subject I am convinced that protoxide of nitrogen 
will supersede, to a considerable extent, some of our 
most reliable and popular remedies, while at the same 
time it will render the prevention and resolution of 
many of the ordinary forms of disease more certain, 
speedy, and decided ; and, moreover, afford the means 
of removing some of those peculiar abnormities now 
not at all or but slightly amenable to the present thera- 
peutic measures. 

In view, therefore, of its peculiar and valuable sani- 
tive properties, nitrous oxide promises to be a very 
efficient general substitute for some of the most potent 
and expensive remedial agents known, such as for 
instance, alcohol, ammonia, quassia, strychnia, mercury, 
and others, variously classified as diffusible and perma- 
nent stimulants, tonics, antiperiodics, antispasmodics, 
alteratives, secernents, etc. Among those which it may 
thus more or less completely replace is that peculiar 
and valuable remedy quinia, and as a succedaneum, 
therefor, as well as in some measure the other medicinal 
agents referred to, I present it for particular consider- 
ation. 

While, however, it will thus, to a great extent, be- 
come a substitute for, and better subserve the sanitive 
purposes of a number of potent remedies, it cannot, of 
course, meet efficiently the necessities of the case where 
there is a privation of the normal components of the 
economy otherwise than those of its own constituents, 



20 MEDICAL PROPERTIES AND APPLICATIONS OF 

for in the absence of some simple or compound organic 
substance like lime, iron, phosphorus, albumen, fibrin, 
etc., it could not be expected to supply the deficiency, 
although even here it will often prove indirectly service- 
able by rousing the vital energies to that degree of 
activity necessary to their appropriation or develop- 
ment from the regular sources of nutrition, as it directly 
increases the strength of the body, stimulates the func- 
tions of assimilation, improves digestion, and sharpens 
the appetite, while at the same time furnishing within 
itself certain important elements of aliment, usually 
supplied in a gaseous state by the atmospheric air 
through the pulmonary organs; nutritive, like other 
matter being in the several forms of solids, liquids, and 
gases, principally introduced into the more complex 
organisms through the common channels of the stom- 
ach and lungs. Protoxide of nitrogen thus acts in the 
double capacity of a nutritive and remedial agent com- 
bining the properties of an article of both the materia 
alimentaria and materia medica, presented in a form 
suitable for hygienic and medicinal purposes. Hence 
presupposing the due proportion in quality and quan- 
tity of other essential elements of alimentation, nitrous 
oxide will always, caeteris paribus, prove more or less 
useful within the range of its capabilities both mate- 
rially and dynamically. 

But passing from such general reflections to a par- 
ticular consideration of the medicinal influences of this 



PROTOXIDE OP NITROGEN, ETC. 21 

remarkable agent, I will, in order to give a more defi- 
nite view of the special properties and applications of 
protoxide of nitrogen, present a general outline thereof 
so far as the current imperfect nomenclature will per- 
mit. Thus in comprehensive terms, nitrous oxide is a 
direct, potent, and permanent chemico-organic, arterial, 
nervous, cerebral, and general stimulant, secernent, de- 
purant, aphrodisiac, and antitoxic, having a special 
tendency to the blood, brain, nervous system, and genito- 
urinary organs. It exerts a powerful invigorating in- 
fluence over the entire economy and is a superior nutri- 
ent, haematic, neurotic, tonic, disintegrant, diuretic, 
disinfectant, alterative, resolvent, sorbefacient, antidote, 
antiseptic, etc. etc. Its primary action is usually prompt 
and frequently well marked, though somewhat transi- 
tory in character, while its secondary or more remote 
effects are permanent and highly salutary, the difference 
between them being more in degree than in kind, for, 
as before stated, the invigoration is generally con- 
tinuous and persistent without subsequent depression, 
as is the case with most other stimulants. The prop- 
erties and influences of nitrous oxide are, in other words, 
both organic and dynamic; organic in supplying the 
material elements — nitrogen and oxygen — for the vari- 
ous chemical purposes of the economy ; and, dynamic 
in stimulating the functions of the whole body. Thus 
both through its constituent elements and dynamic in- 
fluences it promotes the chemico-organic and dynamic 



'2'2 MEDICAL PROPERTIES AND APPLICATIONS 01 

operations of the animal organism, and while the 
'---*:'-' '"'-- -.'-'.- rescues as well as prevents abnor- 
mal action. 

In conseqnence, its peculiar chemical 

constitution an;; saa:::~e : ;::;- 

gen is est: y applicable t; he :orreetion as well as 

prevention of numerous derangements of an atrophic 
and adynamic character, whether prii lary, 

antecedent or consequent. Its power of thus 
and removing disease of an asthenic nature more par- 
ticularly, both general and local, organic and dynamic, 
primary and secondary, acute and chronic,, is — accord- 
ing to my own experience — certainly very great and 
often strikingly ma: From its marked pra: 

value in the prophylactive and curative treatment of 
the more common types of disease it will, doubtless, 
also prove extremely useful in preventing and resolving 
some of those of a peculiar character now not at all or 
but partially, amenab ae ordinary remedial in- 

fluences. 

In general nitrous oxide is of great utility in the 
f those asthenic con a in which the 

: ' :esses of the animal e 

omy are in abeyance, and which are so frequently ex- 
hibited in the inertia of the various functions of the 
organism, those of the vegetal, animal, and psycfc 
life inclusive. I: is therefore especially indicated in 
indigestion and inefficient absorption, as also in general 



PROTOXIDE OF NITROGEN, ETC. 23 

inactivity of the chylopoietic functions; in imperfect 
aeration or arterialization of blood and deficient hserua- 
tosis; in raal-assimilation and disintegration; in insuf- 
ficient secretion and depuration; and, in irregular or 
defective motility, contractility, innervation, and cere- 
bration. Hence in the various forms of asthenic dys- 
pepsia and other morbid states dependent upon or 
associated with torpidity of the chylopoietic viscera ; 
anseration, anaematosis, and mal-nutrition generally, 
both primary and secondary; in depraved and defective 
secretion and depuration ; in enervation, neuralgia, 
chorea, paralysis, melancholy, amentia, and adynamic 
states generally, the nitrous oxide will, doubtless, 
always prove more or less useful as a curative agent. 

Protoxide of nitrogen is moreover, strongly indicated 
in atonic conditions of the genito-urinary apparatus, 
more especially in inertia and such other abnormities 
of the urinary and reproductive organs as are presented 
in cases of incontinence and suppression of urine, pa- 
ralysis of bladder, spermatorrhoea, impotence, sterility, 
some forms of amenorrhcea, dysmenorrhea, leucorrhcea, 
menorrhagia, etc., as it has a special tendency to these 
organs, and exerts a powerful influence over their 
functions. 

But the applications of nitrous oxide are not exclu- 
sively limited to the more purely atrophic and adynamic 
states, as it is available for the successful treatment of 
some forms of both general and local hypertrophy, and 



METICAL PROPEEIZIS ANSI ASmJCATUXSS :i 

mal- organization. Thus, for ins in the undue or 

abnormal production of adipose, fibrous, and other tis- 
sues, as in obesity, enlargement and fatty degeneration 
of the heart and other par:s if seems : - effi- 

ciently by superoxidation or otherwise in resolving such 
abnormities, and in restoring the equilibrium of nutri- 
tion, innerva:: :;:;: motility, and ton: More- 
over, in rarious analogous conditions, :; ;s ^ephan- 
tiasis, phlegmasia dolens. and similar general and local 
hypertroph s it will doubtless als i] as a 
remedial if not a curative agr 

Among those general mor states be I he curative 
treatment of which the nitrous »xkle is more particu- 
larly applicable are those which precede and give r 
to, or are coincident with va: :onal dis- 

orders, such as scrofula, consumption, and other affec- 
tions of a like charac.r: It is not 7 uefn] in cor- 
recting such cachexia and in averting their sequel 
but likewise, to a considerable extent in res >ing these 
latter. This agent, protoxide of nitrogen, will dou: - 
less also remove as well as prevent other abnormities of 
an asthenic character which are more or less dependent 
upon a special diathesis, and besides favorably mod 
if not entirely subvert the latter. But as I have al- 
ready referred to some of these and a special detail will 
unduly extend this communication, I will merely allude 
in a rery general wa~ :: soeh as are most prominent, 
and refer those interested for a more extended notice 



PROTOXIDE OF NITROGEN, ETC. 25 

thereof to the published papers before mentioned, 
particularly to those respectively entitled Anaeraatosis, 
Hsematosis, and Glucosis. Thus, for instance, in those 
forms of deranged nutrition and innervation attended 
with an abnormal production of fibrin and fat, as in 
polysarcia, and especially in that variety known as adi- 
posis, the nitrous oxide is of great practical value in 
causing these substances to undergo their ultimate 
metamorphosis and final disorganization, and in re- 
storing the healthy balance of the economy. Through 
its chemico- organic and bio-dynamic action protoxide 
of nitrogen will likewise transform and disintegrate, as 
well as prevent the undue production of albumen and 
sugar, and thus counteract their attending diseases, 
albuminuria and glucosuria with their sequelae, the de- 
velopment of all of which I regard as dependent in the 
main, upon a constitutional dyscrasia, believing that a 
similar diathesis is generally concerned in the excessive 
production of such normal substances as sugar, fat, 
albumen, fibrin, etc., as in that of an abnormal matter 
like tubercle or cancer, although they might also be 
engendered independent of any direct constitutional 
predisposition.* 

But in the treatment of the special manifestations of 
such cachexia — which are numerous, diversified, and 
complicated — nitrous oxide is also of great practical 

* This view, which was formally presented years ago, is sup- 
ported by the results of recent investigations. 

3 



26 MEDICAL PROPERTIES AND APPLICATIONS OF 

value, for though not altogether adapted to every de- 
gree and variety of these secondary affections it is of 
great general utility in many if not all. Hence to de- 
rive the utmost benefit from its use in such cases it 
must be exhibited with due regard to the particular 
type, stage, intensity, and complications of the local 
disorder, for notwithstanding always more or less 
strongly indicated in these maladies to correct the 
constitutional derangement and subvert, remove, or at 
least modify its destructive sequela?, yet it is not always 
admissible in every stage of the secondary lesion, es- 
pecially when of an actively irritable or inflammatory 
nature and of a sthenic character, but in the subacute 
and chronic condition, particularly of an asthenic type, 
it is mostly of superior value. 

Thus, for instance, in phthisis, in which it is very 
useful in promoting healthy arterialization, haBmatosis, 
assimilation, secretion, and innervation, and in relieving 
oppression of breathing, cough, and other distressing 
symptoms, it must be exhibited with due regard to the 
local complication, for if given too freely during active 
inflammation or tuberculous colliquation, it may pro- 
mote the destructive process and hasten the fatal term- 
ination, whereas if employed in proper quantities with 
just discrimination, it will tend in all stages, to dimin- 
ish morbid action, remove abnormal matter, rectify 
constitutional derangement, and restore the normal 
organic and dynamic status of the economy. 



PROTOXIDE OF NITROGEN, ETC. 27 

Again in another class of secondary affections con- 
nected with the abnormal deposit or undue production 
of such normal substances as sugar, fat, albumen, etc., 
in which it is very efficient, nitrous oxide must be em- 
ployed with the same restrictions in order to derive the 
utmost benefit. This is particularly the case in those 
disorders engendered by a more immediate eliminative 
effort on the part of certain organs like the kidneys, to 
remove from the body an excess of such matters, and 
which are manifested in the various forms of glucosuria, 
albuminuria, renal irritation, congestion, inflammation, 
degeneration, and disorganization with their destruc- 
tive concomitants. In these cases in suitable quanti- 
ties, properly exhibited, nitrous oxide will doubtless 
always prove more or less useful not only by directly 
transforming, disintegrating, and preventing the further 
excessive development of such offending substances, rec- 
tifying the constitutional cachexia, restoring the healthy 
balance of innervation, nutrition, secretion, and elimi- 
nation, but also by resolving more or less completely 
the consequent local lesion. 

As a curative agent in glucosuria- of a mild form 
nitrous oxide is especially active, for I have repeatedly 
seen the saccharine condition of the urine rapidly dis- 
appear under its use, but of its remedial efficiency in 

i 
the extreme cases of this affection, I am unable to 

speak from practical experience, never having had an 
opportunity of treating such an abnormity. Neverthe- 



28 MEDICAL PROPERTIES AND APPLICATIONS OF 

less, for the cure as well as prevention of all forms of 
that peculiar malady known as diabetes — -except per- 
haps, the traumatic variety so long as it is thus directly 
dependent upon the state of traumatism, or in cases 
of great disorganization of structure — I am confident 
protoxide of nitrogen will, caeteris paribus, prove a 
specific. Moreover, I firmly believe this agent will 
also materially modify if not entirely remove the vari- 
ous tuberculous, cataractous, and other sequelae of the 
glucosic cachexia. Hence, with the exception men- 
tioned, in every grade and variety of the glycogenic 
disorder, even if attended with extreme modification of 
structure, nitrous oxide promises to prove of great 
remedial value. For the curative treatment, therefore, 
of the glycogenic diathesis and the various derange- 
ments of the body connected therewith, both functional 
and organic, and especially those forms known as glu- 
cosuria, diabetic cataract, and other concomitant local 
lesions, protoxide of nitrogen is particularly recom- 
mended as a very promising remedy. It may probably 
also exert a beneficial influence to some extent, at least, 
iu modifying or resolving other varieties of cataract 
and analogous alterations of structure in different parts 
of the economy. 

In the numerous sequelae of such diatheses as scrofu- 
losis, adiposis, albuminosis, and others of a like char- 
acter so frequently presented in the forms of depraved 
nutrition, defective or degenerate structure, modified 



PROTOXIDE OF NITROGEN, ETC. 29 

secretion, and the various inflammatory complications 
of the different tissues and organs, nitrous oxide is also 
generally applicable with the same restrictions as to the 
special contraindicating circumstances before mentioned. 
Hence, cseteris paribus, in scrofula, fatty, waxy, and 
similar modifications of tissue, albuminuria, chyluria, 
oxaluria, etc., with or without dropsy, it may be ex- 
hibited somewhat freely, but in the more acute and 
advanced states of sthenic irritation or inflammation 
it should be carefully employed, if at all, in very small 
quantities, for though always more or less strongly 
indicated to correct the constitutional dyscrasia, pro- 
mote normal metamorphosis, resolve local lesions, re- 
store and regulate the healthy action of both the gen- 
eral system and particular part affected, yet if given 
unduly or inappropriately it will be apt to increase the 
inflammatory action and the tendency to disorganiza- 
tion of the implicated structure. The use of protoxide 
of nitrogen is therefore mostly contraindicated in all 
such actively irritable or inflammatory states, even of an 
asthenic nature, and especially of the cerebral, cardiac, 
hepatic, or renal organs. This is particularly the case 
in the several nephritic complications of the character 
referred to, and among others the so-called Bright's 
disease in which nitrous oxide may frequently be em- 
ployed with benefit, if given in small quantities at a 
time and with such other precautions as not to increase 

3* 



BO MEDICAL PROPERTIES AND APPLICATIONS OF 

uraemia or unduly stimulate the affected organ and gen- 
eral system. 

The same principles apply with even greater force in 
another species of secondary disorder of which rheu- 
matism and gout are examples. In such abnormities 
nitrous oxide is also highly useful in correcting both 
the constitutional and local derangement when of a 
chronic character, but is as a rule, inadmissible in the 
acute form in consequence of the active tendency to 
cardiac inflammation, and for the same reason more or 
less objectionable in the subacute condition, though to 
a certain extent beneficial therein, when exhibited in 
moderation and with due discrimination. In the first 
variety, however, notwithstanding it occasionally seems 
to temporarily develop or augment pain* and excite- 
ment from a disproportionate quantity, perhaps, yet by 
modifying the general dyscrasia, removing the imme- 
diate cause of disturbance, and restoring the healthy 
equilibrium of system, it sometimes speedily resolves 
the abnormity altogether. 

It will thus be seen that protoxide of nitrogen has a 
very wide range of therapeutical application in that 
class of maladies connected with the undue or irregular 
production of such substances indicated, especially when 
of an amyloid, glucoid, ceroid, adipoid, albuminoid, or 



* Thai it will thus sometimes momentarily develop pain was 
long since observed by Sir Humphrey Davy, •• Researches 

on Nitrous Oxide." 



PROTOXIDE OF NITROGEN, ETC. 31 

pigmentary character. Hence in the various concom- 
itant lesions of nutrition and innervation manifested in 
the different modifications and degenerations of struc- 
ture from abnormal formative or disintegrative meta- 
morphosis, whether of a benign or specific nature, and 
particularly in the many analogous abnormities of the 
kind in the tissues of the hepatic, cardiac, ophthalmic, 
renal and other organs and parts of the body, nitrous 
oxide will, no doubt, prove as generally useful as it has 
heretofore specially. 

As already intimated in those other diathetic de- 
rangements of nutrition and secretion attended with the 
undue or extraneous development of such substances 
as cholesterine, oxalic acid and their analogues, nitrous 
oxide will doubtless also prove practically useful in cor- 
recting the abnormal and in restoring the normal action 
of the molecular and somatic life as well as the special 
functions and organs more immediately implicated. 
From its superior power in modifying general nutritive, 
dynamic, and secretory action, I believe protoxide of 
nitrogen will thus prove of great value in preventing 
and, perhaps, also in causing the destructive disintegra- 
tion as well as expulsion of certain adventitious concre- 
tions in different parts of the body, and particularly 
some of the varieties of biliary and urinary calculi. The 
special type or variety of lithiasis to the treatment of 
which it seems most applicable is that resulting from an 
organic deficiency of its constituent elements, oxygen 



32 MEDICAL PROPERTIES AND APPLICATIONS OF 

and nitrogen, although it is not improbable that it may 
likewise be efficient in preventing the development of 
other forms of calculi in which these elements are not 
so immediately concerned through its general chemico- 
organic and bio-dynamic influence in modifying morbid 
constitutional and local tendencies, and in promoting 
healthy metamorphosis, innervation, depuration, and 
elimination. Hence, as an antilithic it may be resorted 
to in the confident hope that it will often meet to some 
extent, at least, both the general and special indica- 
tions and be thus directly and indirectly useful. 

That protoxide of nitrogen will act very promptly 
and efficiently in promoting haematosis and the 
general assimilative, disintegrative, and excretory 
processes — particularly those more immediately con- 
nected with the renal organs — I am well satisfied, 
from much observation and experience. Indeed, in 
these respects it is not surpassed, if equalled, by any 
other known agent, and especially in the character 
of its effects upon the kidneys, as it not only actively 
promotes the secretion of urine, but also greatly influ- 
ences its healthfulness, both in quantity and quality. 
Nitrous oxide is thus, in fact, a most potent and 
peculiar diuretic ; for, unlike other remedies of this 
class, while it directly increases the solid components 
of the urine, and particularly ure*a, it at the same 
time regulates and facilitates the elimination of the renal 
secretion, arterializes and purifies the blood, gives tone 



PROTOXIDE OF NITROGEN, ETC. 33 

to the tissues, strengthens the nervous, and invigorates 
the whole system. It is hence applicable to the pre- 
ventive and curative treatment of quite a number of 
urinary affections, — such, for instance, as anuria, 
anazoturia, chyluria, oxaluria, and other varieties of 
lithuria, dysuria, hydruria, hsematuria, enuresis, cystor- 
rhcea, paralysis of bladder, and others of a similar 
character. 

Besides those thus indicated, there are various other 
abnormities, apparently unconnected with any special 
diathesis, constantly presented in the different forms of 
asthenic hyperaemia, congestions, inflammations, serous, 
haemorrhagic and plasmatic effusions, and depraved, 
diminished, or excessive secretion within or from the 
several parts of the body, — particularly of the pulmo- 
nary, alimentary, and genito-urinary organs, in which 
nitrous oxide is also generally useful. Hence, in the 
several maladies of the kind, and especially in such 
conditions as diffused anasarca and localized dropsy, 
catarrhus, diaphoresis, diuresis, leucorrhcea, diarrhoea, 
cholera, and similar internal and external defluxions, it 
may frequently be employed with decided advantage. 

This agent — protoxide of nitrogen — is also useful 
for the removal of those constitutional disorders upon 
which such affections are so frequently dependent, — as, 
for instance, anaemia, bydraemia, chlorosis, and other 
forms of mal-nutrition and debility. 

While, however, the therapeutical applications of 



34 MEDICAL PROPERTIES AND APPLICATIONS OF 

nitrous oxide are so varied and important in this 
direction, they are not thus exclusively limited to the 
more purely vegetal or organic, as it is also of extensive 
use in the animal and psychical life, — being exceed- 
ingly valuable in adynamia of the brain and nervous 
system. Thus in the numerous asthenic derangements 
of innervation and cerebration manifested in the dif- 
ferent forms and degrees of enervation, anaesthesia, 
neuralgia, imbecility, mental depression, hypochondria, 
delirium and similar mental states, it is generally ap- 
plicable. By regulating vital action and intensifying 
all the functions of life, protoxide of nitrogen often 
proves very efficient as an anodyne, hypnotic, and 
general nervine, in correcting undue excitability of 
body and mind, relieving pain and suffering, promot- 
ing sleep, removing vital inertia and atony, and in 
restoring the healthy balance of the economy. 

In addition to these aberrations of general innerva- 
tion and intellection, there are others connected with 
special sensation, contractility, and motion, in which 
nitrous oxide is also more or less strongly indicated. 
It is hence applicable in spasm, torpidity, debility, 
and paralysis, whether local or general, partial or 
complete, acute or chronic, — as in chorea, epilepsy, 
amaurosis, hemiplegia, paraplegia, and analogous con- 
vulsive and atonic disorders. As an antispasmodic, 
antiparalytic, and corroborant, it is thus of general 
application in the treatment of all such affections 



35 



dependent upon an adynamic state, either of molecular 
or somatic life, and not on defective nutrition, from 
the absence of some organic element, especially of the 
neural matter, — as phosphorus, fat, albumen, osma- 
zome, etc.; for it is obvious that in all cases of starva- 
tion of brain, nerve, muscular or other tissue, neither 
protoxide of nitrogen nor any other agent can be of 
more than incidental service, unless they supply the 
very elements of structure required. Hence, in order 
to derive benefit from this or any other remedy, it is 
necessary to previously insure healthy alimentation by 
introducing into the economy the requisite elements of 
nutrition in such quantities and form best adapted to 
supply the special organic deficiencies ; and secondarily, 
to resort to such extraneous measures as may be essen- 
tial to promote assimilation and normal life action. 

These very general remarks will serve to show that 
protoxide of nitrogen has an extensive range of thera- 
peutic as well as hygienic application, and especially in 
subacute and chronic conditions of an asthenic nature. 
While, however, it is usually most applicable in such 
morbid states, yet it is not thus exclusively limited, as 
it is also serviceable in the treatment of many other 
disorders of an adynamic character, in their more 
active or acute, as well as in their secondary or atonic 
stage. But as the notice of this class of maladies 
involves to some extent, the consideration of the 
revivifying and antidotal properties and applications 



36 MEDICAL PROPERTIES AND APPLICATIONS OF 

of nitrous oxide, I will proceed to point out its merits 
in this direction. 

2. The revivifying properties of protoxide of nitro- 
gen are also very peculiar and striking, though closely 
resembling those of its congener — atmospheric air. 
The special character of these might, indeed, be readily 
anticipated from its kown chemical constitution and 
chemico- organic and bio -dynamic influences; but, 
independent of all such a priori considerations, expe- 
rience proves that nitrous oxide is, in fact, of great 
practical value in the treatment of many depressed, 
asphyxiated, and toxic conditions of the system, by 
supplying to the suffering organism those essential 
elements of alimentation, — oxygen and nitrogen, — 
restoring the healthy equilibrium of arterialization and 
innervation, promoting normal nutrition and depura- 
tion, and in accelerating the general organic and 
dynamic processes of life. 

Protoxide of nitrogen is thus of great utility in 
relieving those abnormal states resulting from a priva- 
tion or contamination of atmospheric air. Hence it is 
especially indicated in the numerous disorders engen- 
dered by impure air, as well as in those caused by 
a more or less constant deficiency of atmospheric air 
from defective ventilation, sedentary habits, and other 
unnatural modes of living. Besides these slow and 
insidious, though no less certainly destructive methods 
of strangulation, nitrous oxide will prove useful in 



PROTOXIDE OF NITROGEN, ETC. 37 

those more rapid and extreme cases of asphyxiation 
consequent upon apncea, hanging, and other forms of 
suffocation, — including, doubtless, that from drowning, 
although my own experiments in this direction have 
not been very satisfactory.* 

This agent may also be employed with advantage in 
asthma, cyanosis, the asphyxia of newly born infants, 
and in suspended animation generally, whether partial 
or complete, temporary or prolonged, for so long as 
the blood remains uncoagulated and molecular life is 
sufficiently active to admit of revivification, even when 
so much in abeyance as to appear entirely beyond the 
reach of any stimulus, protoxide of nitrogen will afford 
a most efficient means of resuscitation, as it exerts a 
powerful influence in promoting all the functions of the 
animal economy, — especially those of arterialization, 
hsematosis, circulation, respiration, innervation, and 
muscular and general tonicity, f 

As, however, much of the danger in such asphyxiated 
conditions is dependent upon the generation and reten- 
tion of noxious matters within the economy, nitrous 
oxide will not only be indirectly useful in subverting 
their effects, by directly arterializing the blood, stimu- 
lating the nervous and invigorating the general system, 
but also, more immediately active as an antidote, in 
chemically combining with or decomposing such delete- 

* Boston Med. and Surg. Jour., vol. xlvii. No. 19. 
•(-Boston Med. and Surg. Jour., and Med. and Surg. Rep. 

4 



38 MEDICAL PROPERTIES AND APPLICATIONS OF 

rious substances, and in promoting their elimination 
from the body. 

3. The antidotal influence of protoxide of nitrogen 
may, therefore, be said to be of a compound character, — 
acting in the threefold capacity of neutralization, de- 
composition, and elimination. 

The peculiar constitution and properties of nitrous 
oxide thus render it not only powerfully antagonistic to 
all enfeebled, depressed, and asphyxiated conditions, 
but also more or less so to a variety of pernicious influ- 
ences and numerous toxic states from divers noxious 
agents, which may be generated within or be introduced 
from without the body. The beneficial applications of 
protoxide of nitrogen is hence not restricted exclu- 
sively to cases of suspended animation from privation 
of atmospheric air and the retention of excrementitious 
matters within the economy, but is likewise extended 
to those adynamic and toxic conditions of system result- 
ing from a poisoned-state of the fluids and solids of the 
body and prostration of the vital energies from the 
pernicious operation of certain deleterious agencies of an 
internal or extraneous origin, whether of a so-called 
malarial or miasmatic nature, and of an infectious or 
contagious character. It is, therefore, particularly 
indicated in the various ataxic and adynamic fevers, 
such as the typhus, typhoid or enteric, congestive, 
yellow, remittent, intermittent, and all others of a sim- 
ilar type. Nitrous oxide is moreover of general 



PROTOXIDE OF NITROGEN, ETC. 39 

application and quite efficient in scarlet fever, measles, 
diphtheria, variola, constitutional syphilis, erysipelas, 
gangrene, and kindred maladies. It may likewise prove 
more or less useful in sunstroke, pyaernia, purulent 
infection, puerperal fever, and necrasmic and toxicaemic 
affections generally, those from septic poisons and the 
virus of venomous and rabid animals inclusive. 

The stimulant, depurant, and antidotal properties of 
protoxide of nitrogen also render it peculiarly valuable 
in the treatment of another variety of toxicosis from the 
inordinate and continued use of alcohol, tobacco, and 
opium, as well as in those sudden and dangerous states 
of intoxication from over-doses of the same, and the 
poisonous effects of belladonna, aconite, hydrocyanic 
acid, chloroform, carburetted hydrogen, carbonic acid, 
and perhaps also all others of a like character. 

From this cursory sketch it will be apparent that 
protoxide of nitrogen has a very extensive range of 
medicinal application, and, caeteris paribus, is well 
adapted to the curative treatment of all depressed, 
morbid, and toxic states in which a chemico-organic, 
arterial, nervous, cerebral, and general stimulant, nu- 
trient, alterative, resolvent, absorbent, secernent, anti- 
septic, antitoxic, and revivifying influence is required. 

4. As an anaesthetic, protoxide of nitrogen is also 
unique, differing essentially from all other agents of the 
kind in chemical constitution, physical properties, and 
physiological influences, for these latter are not only 



40 MEDICAL PROPERTIES AND APPLICATIONS OF 

chemically dissimilar, but always more or less directly 
sedative in their action upon the animal organism ; 
whereas, the former is ab initio primarily and perma- 
nently stimulant, not even being followed, unless in 
exceptional cases, with any of that languor or depres- 
sion so peculiar to the others. Thus, for instance, in 
regard to constitution, while most other anaesthetics are 
composed principally of the elements hydrogen and 
carbon, the sole and exclusive constituents of nitrous 
oxide are oxygen and nitrogen. Besides in their relative 
effects upon the living economy there is as great a 
disparity between protoxide of nitrogen and all other 
agents employed for the production of insensibility as 
there is in composition. This is especially manifest in 
the action of those representative anaesthetics, — chloro- 
form and ether, for the former, as elsewhere stated,* not 
only directly prevents aeration of the blood, but, doubt- 
less, also deoxidizes that fluid and diminishes general 
chemico-organic action, stupefies the brain, depresses 
the nervous system, causes relaxation of the muscular 
and other tissues, paralyzes the heart, and thus produces 
death, — its tendency being, in fact, to prostrate the vital 
energies and destroy life by direct and positive sedation ; 
while ether, though primarily somewhat stimulant to the 
brain and nervous system, and less immediately active 
in arresting oxidation and metamorphosis, and in in- 

* Dental Cosmos. 



PROTOXIDE OF NITROGEN, ETC. 41 

during insensibility, stupor, and paralysis, is yet ulti- 
mately depressing and destructive, much in the same 
way as its congener. Hence the process of anesthetiza- 
tion as thus accomplished, is a process of devitalization, 
and the anaesthetic condition a state of suspended 
animation artificially produced, the truth of which is 
demonstrated by the fact that this, approximate or 
partial, often proceeds, notwithstanding the utmost 
care, to complete and absolute death. These agents 
are, therefore, positive and powerful sedatives if not 
altogether in their immediate, certainly in their more 
ultimate effects. 

The physiological influence of nitrous oxide is, how- 
ever, the reverse of this, for, instead of retarding, it on 
the contrary increases oxidation of the fluids and 
solids of the body, stimulates the brain and nervous 
system, augments general and special sensibility, excites 
muscular and general contractility, accelerates molecular 
metamorphosis, promotes general nutritive and vital 
action, invigorates the whole system, and acts as a true 
tonic. Its effects in these respects are indeed so well 
marked as to place it in direct antagonism to the 
various sedatives and render it very efficient in not 
only counteracting their depressing influence by direct 
stimulation, but also to some extent as an antidote 
thereto. There is, therefore, a wide difference both in 

constitution and properties between these respective 

4* 



42 MEDICAL PROPERTIES AMD APPLICATIONS OF 

agents and nitrons oxide ; for, while the former arrests, 
the latter promotes and intensifies life action. 

But it may be asked, if snch is the case, how comes 
it that protoxide of nitrogen acts as an anaesthetic at 
all ? for it is well established that it will produce 
insensibility, a fact long since observed by Sir Hr :■;- 
phrey Davy,* and abundantly verified by recent ex- 
perimentation. This effect of nitrons oxide was indeed 
so i it led him to suggest its 

applicability for the relief of pain from surgical 
operations, as the following extract from his work will 
show.f "As nitrous oxide in its extensive operation 
appears capable of destroying physical pain, it may 
probably be used with advantage during surgical 
operations in which no great effusion of blood takes 
place." 

N twithstanding, however, this recognition of the 
property of nitrous oxide to cause insensibility and his 
suggestion for its employment to allay pain, it does not 
appear that Davy, himself, either made, or urged others 
to make, any practical application of his thought, 
and much less foresaw its extreme usefulness in this 
direction; nor even, that he sufficiently appreciated 
the importance of the fact to induce him to further 
examine the subject With Davy, therefore, this was 
apparently but a mere casual observation and sugges- 

* Vids Researches* on Nitrous Oxide. 
f Ibid., p. 329. 



PROTOXIDE OF NITROGEN, ETC. 43 

tion without special investigation or apprehension of 
the anaesthetic properties of nitrous oxide or general 
anaesthesia. But it was far otherwise with another to 
whom must be accredited the wonderful discovery of 
anaesthesia, both on the principle of a priori apprecia- 
tion and a posteriori demonstration. This was Dr. 
Horace Wells, whose mind from the first was deeply 
impressed with the idea of the possibility of speedily 
producing general insensibility in order to render 
operations painless, and the belief that some means 
existed whereby this might be promptly effected and 
suffering thereby completely obviated. This conviction 
led to research, and the moment the fact was presented 
to him that nitrous oxide was capable of producing 
insensibility it was seized upon with avidity, and the 
practical application immediately made by an expert- 
mentum crucis on his own person in having a large 
molar tooth extracted while under its influence, which, 
as he anticipated, was effected without pain, thus 
proving conclusively the correctness of his preconcep- 
tions respecting the feasibility of anaesthesia. 

With regard, therefore, to the relative merits of these 
pioneers of anaesthesia there can be little doubt, for 
while Sir Humphrey Davy is clearly entitled to the 
credit of having first observed the anaesthetic properties 
of nitrous oxide, and suggested its application for the 
relief of pain in surgical operations, to Dr. Horace 
Wells is unquestionably due the immortal honor of 



44 MEDICAL PROPERTIES AND APPLICATIONS OF 

having made the first practical demonstration of anaes- 
thesia by means of this agent, its primary selection for 
the purpose being apparently more the result of accident 
than design, for it is very doubtful whether he had any 
previous knowledge of Davy's observation, or had ever 
before even thought of nitrous oxide in connection with 
anaesthesia. His claim rests, therefore, upon originality 
of conception as well as priority of exposition and prac- 
tical application of anaesthesia. This great discovery 
was thus the direct product of preconceived thought 
and intelligent research on the part of Dr. Wells, to 
whom the world is thereby so largely indebted that it 
cannot, by any posthumous honors, do more than ac- 
knowledge its, obligations for benefits conferred, yet 
may, to some extent, manifest its gratitude by an ample 
endowment for the support of his bereaved and indigent 
family, which it is hoped will be speedily done. 

But to return from this digressive though pertinent 
inquiry respecting the discovery of anaesthesia to the 
consideration of the modus operandi of nitrous oxide 
in the production of insensibility. As before stated, 
the ordinary effects of protoxide of nitrogen upon the 
animal economy are actively and permanently stimulant, 
accelerating all the vital operations by increasing 
chemico-organic and bio-dynamic action. Thus while 
chemically it rapidly arterializes the blood and promotes 
elemental interchange, molecular activity and organic 
metamorphosis, dynamically it stimulates the nervous 



PROTOXIDE OF NITROGEN, ETC. 45 

system, sensorium and general functions of life. But 
when taken freely the physiological processes are ac- 
celerated to such a degree as to temporarily overcome 
systemic excitability and cause partial interruption of 
vital activity from overstimulation, the stimulus over- 
balancing excitability or the momentum being greater 
than the velocity, on the same principle as without 
exhaustion a horse may be "taken off its feet," and its 
pace materially diminished by immoderate driving, the 
impetus being greater than its capacity for speed. Be- 
sides this there may probably be such an abundance of 
carbonic acid engendered by the energetic oxidation as 
to check in some measure ehemico-organic reaction and 
dynamization, and thus induce vital inertia and insensi- 
bility. Dynamically the sensorial centres may also be 
so greatly overexcited as to be unable to respond to 
any additional stimulus, or their functions be partially 
suspended by local hypersemia from undue activity of 
the organs concerned in innervation and circulation, as 
well as from the excessive quantity of carbonic acid 
from superoxidation. Moreover, some of the effects of 
nitrous oxide may result from the compounds of nitro- 
gen with hydrogen and carbon, as ammonia, cyanogen, 
etc., they being of a mixed stimulant and tranquillizing 
character. In these and perhaps also some other more 
occult modes, sentient impressibility may be so materially 
diminished by protoxide of nitrogen as to cause partial 
or even entire suspension of sensibility and conscious- 



46 MEDICAL PROPERTIES AND APPLICATIONS OF 

ness. This power of nitrous oxide to produce anaes- 
thesia by superoxidation, overstimulation, etc., is quite 
distinct from that of all other agents more especially of 
the hydro-carbonaceous variety, for they induce the 
anaesthetic condition by non-oxidation and deoxidation 
of system, and by directly checking chemico-organic 
reaction and annihilating sensibility and consciousness. 
The former, therefore, increases while the latter dimin- 
ishes life action, with, in both instances, the same 
general result of insensibility of body and unconscious- 
ness of mind, though relatively as different in character 
from each other as sleep is from stupor or satiety from 
starvation. 

The anaesthetic effect of protoxide of nitrogen is 
therefore, the result of vital exaltation instead of de- 
pression, being similar in character to that state of 
impassibility to injury engendered by exquisite pleas- 
ure, moral exaltation, great mental preoccupation and 
excitement, or undue concentration of nervous energy 
upon any one part of the system with diminished 
sensibility elsewhere, and vigorous tonicity of body, 
examples of which are presented in numerous physio- 
logical and pathological conditions, as for instance, in 
the exaggerated feeling with concomitant systemic 
insensibility of high social, religious, or political en- 
thusiasm, and other powerful emotional states variously 
exhibited in the indifference to pain during spiritual 
abstraction or inspiration, heroic passion, fanatical 



PROTOXIDE OF NITROGEN, ETC. 41 

frenzy, ecstacy, and to a certain extent, in hysteria, 
insanity and analogous disorders, in all of which there 
is frequently more or less perfect analgesia without 
coincident nor seldom even any great degree of subse- 
quent depression, but sometimes only a mere feeling of 
lassitude with an active tendency to renewed energy. 
• Thus ordinarily with the anaesthetic action of nitrous 
oxide, which instead of being attended with concomi- 
tant or reactive sedation is usually followed by in- 
creased vital power, neither its immediate nor ultimate 
effects commonly causing any temporary prostration 
or permanent debility, but generally on the contrary, 
invigoration of both bodv and mind. 

Instead, therefore, of resembling, nitrous oxide differs 
essentially both in constitution and properties from the 
usual anaesthetics, and is, in fact, directly antagonistic 
and antidotal thereto, its anaesthetic effect being the 
result of a stimulant, and not of a sedative action.* 

Protoxide of nitrogen is thus not only superior in 
chemical constitution and the nature of its primary 
effects upon the economy, but also, in leaving a per- 
manent feeling of general invigoration instead of that 
sedation always in a greater or less degree attending 
the action of ordinary anaesthetics ; and, moreover, in 
being in a large measure, unattended with that imme- 



* Vide Dental Cosmos, vol. i. No. 12, and Boston Med. and 
Surg. Journ., vol. xlvii. No. 19. 



48 MEDICAL PROPERTIES AND APPLICATIONS OF 

diate or subsequent danger which render the latter, in 
the main, so objectionable. 

By thus unduly intensifying the general functions of 
life, and especially those of the brain and nervous sys- 
tem, protoxide of nitrogen overcomes systemic exci- 
tability sufficiently to render the body insensible to, and 
the mind unconscious of impressions which would other-* 
wise occasion pain and suffering. Although, as before 
stated, this condition of body and mind is quite distinct 
from that caused by ether, chloroform, and similar 
agents, it is yet in a measure attended with the same 
general results in the production of a state of insensi- 
bility sufficient in degree to admit of certain surgical 
manipulations without the usual concomitant pain. 
This state of anaesthesia from nitrous oxide is usually, 
however, of very brief duration, terminating speedily 
and somewhat suddenly in from one to three minutes,* 
and is hence better adapted for slight and short, than 
for large and protracted operations. 

With regard, therefore, to the relative rapidity, effi- 
ciency, permanency, eligibility, and safety of protoxide 
of nitrogen as an anaesthetic, it may be stated that 
although it will frequently produce insensibility in from 
one to two minutes, yet it is somewhat uncertain and 

* Occasionally it may continue longer, and in one instance, ac- 
cording to Prof. Chesebrough (Dental Register, vol. xix. p. 183), 
the anaesthetic influence was kept up ''from twenty to thirty 
minutes." 



PROTOXIDE OF NITROGEN, ETC. 49 

not very persistent, lasting only about the same length 
of time, unless it is continued by repeated inhalations, 
which may be effected but not with the same facility as 
with other agents. Hence notwithstanding anaesthesia 
may often be thus more promptly induced, it is not, in 
general, so certain, profound, or permanent as that 
from other anaesthetics, and consequently its range of 
application, is necessarily more limited for anaesthetic 
purposes. Its eligibility is also much less, as by the 
present methods and gaseous form, it is much more 
difficult to procure and neither so convenient to handle 
or administer as other anaesthetics, although this diffi- 
culty may probably be partially, if not wholly, over- 
come by its preparation in a liquid state. In safety it 
appears to be greatly superior to other agents of the 
kind, for though not altogether devoid of danger as 
asserted by some, it is doubtless much less in degree 
and mostly of an entirely different character from that 
of ordinary anaesthetics. Besides it has the additional 
advantage of being exempt from the pungent odor, 
sickness of stomach, and other minor disagreeable con- 
comitants, of ether, chloroform, and their analogues. 

While, however, the physiological effects of protoxide 
of nitrogen are usually of a highly pleasurable and 
sanitive character, it cannot, nevertheless, be indiscrim- 
inately employed with safety, for the artificial excite- 
ment of system rapidly engendered by its free admin- 

5 



50 MEDICAL PROPERTIES AND APPLICATIONS OF 

istration, may not only prove injurious by directly 
increasing the tendency to irritation, haemorrhage, and 
inflammation in the parts subjected to surgical mutila- 
tion, but may also develop latent pathological tenden- 
cies of a different as well as of a like character in other 
parts of the body, in persons with certain abnormal 
predispositions, to such a degree indeed, as to seriously 
injure health, if not absolutely endanger life itself. 

The precise character and particular manifestation of 
such tendencies will, of course, depend upon the special 
predisposition of the individual system acted upon, but 
they will necessarily be most likely to appear in certain 
definite parts of the body in accordance with the pecu- 
liarities of action of the disturbing agent — nitrous 
oxide having, as before stated, a marked preference for 
the blood, brain, nervous system, and genito-urinary 
organs. 

These brief observations will suffice to show the gen- 
eral character of the dangers to be apprehended from 
the undue or injudicious administration of nitrous 
oxide, yet as they may not be sufficiently definite for 
practical purposes, I will present a more detailed notice 
of these extraneous tendencies. 

Thus, for instance, the undue excitement occasioned 
by the free or inappropriate use of protoxide of ni- 
trogen, may produce both primary and secondary irri- 
tation, congestion, serous or hsemorrhagic effusion, and 
inflammation in different parts of the body, and espe- 



PROTOXIDE OF NITROGEN, ETC. 51 

daily in the brain and kidneys. Besides, principally 
by superoxidation and overstimulation, it may cause 
excessive disintegration and undue waste as well as 
abnormal excitement of the system, even to destruc- 
tive softening of the brain, nervous tissue, and other 
important structures. Furthermore, by unduly acceler- 
ating functional action it may give rise to rupture of 
the heart and blood-vessels, or disruption and other 
mechanical derangements of important parts of the 
organism. Moreover, through its powerful aphrodisiac 
effects it may intensify sexual desire to such a degree 
as to cause unpleasant exposure or even serious trouble. 
It is probable, also, that dangerous intoxication might 
sometimes ensue from the chemical reactions of the 
elements of protoxide of nitrogen with those of the 
body and the consequent formation in excess of such 
compounds as carbonic acid, cyanogen, ammonia, urea, 
and other substances of the kind. 

In view, therefore, of the highly important consider- 
ations for protecting the general health and insuring 
the safety of those subjected to its anaesthetic influence, 
as well as for the morality of the patient and reputation 
of the operator, nitrous oxide should always be admin- 
istered with due care and precaution. 

Notwithstanding, however, these apparently serious 
objections to the free use of protoxide of nitrogen 
would seem to strongly militate against its general 
employment for anaesthetic and other purposes, yet they 



52 MEDICAL PROPERTIES AMD APPLICATION'S OS 

are materially diminished in : mpensating 

fact, that it lias, in some measure, the ability to coun- 
teract such tendencies, whether antecedent or conse- 
quent, through its material and dynamic power to 
aerate, depurate, and increase the plasticity of the 
blood, encourage healing by first intention, regulate 
innervation, circulation, nutrition, contractility, and 
other essential functions: and. by its general systemic 
invigoration and highly sanitive influence, to pre 
the living organism against any temporary or perma- 
nent injury. While in this way some of the dangerous 
tendencies of this agent are counteracted, it is, never- 
theless, always necessary to bear in mind that such do 
exist and cannot even be slightly disregarded without 
peril, for evil may follow when least expected; hence 
an enlightened judgment and a judicious discrimination 
are constant prereqc in the administration of 

nitrous oxide, in order to form a correct estimate of 
contraindicating circumstance lard against in- 

jurious results. 

Respecting the alleged deaths from the effects of 
protoxide of nitrogen taken for anaesthetic and other 
purposes, there is much doubt, for none of the reported 
cases appear to be sufficiently well marked to justify a 
record against this agent. From a special 
inquiry into the history and character of those nc 
Mr. G. Q. Cqlton, of New York, has arrived at the 
elusion that in no single instance can the death be 



PROTOXIDE OF NITROGEN, ETC. 53 

fairly attributed to the influence of nitrous oxide.* But 
a critical examination of the cases presented seems to 
disprove in some measure, this opinion, for notwith- 
standing it was found in one case that chloroform in- 
stead of nitrous oxide had been employed, and, there- 
fore, the latter had nothing to do with the death of the 
patient, in two other instances it was apparently some- 
what at fault. Thus in the case of S. P. Sears, of New 
York, who died about two hours after its administra- 
tion, it is probable that it hastened death by promoting 
undue pulmonary congestion, if not, also, to some ex- 
tent tubercular colliquation, the post-mortem disclosing 
the existence of intense hypersemia and great disorgan- 
ization of the lungs with constitutional degeneration, 
the patient having been for some time seriously affected 
with consumption. The same principle applies in the 
case of Miss Bell, of St. Albans, Vt., who, it is stated 
by Dr. Gilman, of that place, " inhaled a small dose of 
the gas for sport (not for anaesthetic purposes) with 
several others, on Friday afternoon, January 29th ; came 
out of it as well as any one ever does ; attended a party 
the same evening; as well to all appearance as ever; 
full of life and frolic ; was taken sick the next day 
(Saturday) and died on the Wednesday following. "f 
This death is attributed to cerebro-spinal meningitis, 



* Dental Cosmos, vol. v. p. 490. 
f Ibid. 

5* 



54 MEDICAL PROPERTIES AND APPLICATIONS OF 

and perhaps, justly so, yet it is quite probable that the 
excitant influence of nitrous oxide was injurious in so 
far as it promoted the disorder of the brain and spinal 
marrow, while the fulness of " life and frolic" so freely 
manifested after its use was both an immediate effect of 
its stimulus and a precursor of the fatal affection, it 
being a well-known fact that increased functional ac- 
tivity is a primary and constant concomitant of inflam- 
mation. Hence it is more than likely that in this case 
also nitrous oxide was accessory to the death, even if it 
did no more than encourage an inflammatory tendency, 
and thus partially act as an exciting cause of derange- 
ment, the predisposition previously existing, of course, 
to such a degree as to render the extraneous stimulus 
from this or any other agent absolutely dangerous.* 

These cases serve, therefore, to exhibit the character 
of the danger to be apprehended from the inappro- 
priate or inordinate use of protoxide of nitrogen, and 
if not entirely conclusive within themselves are still 
sufficiently impressive to justify the preceding precau- 
tionary remarks, which it may be stated, were, in the 
main, presented in the pages of the Dental Cosmos 
some time before they were reported. 



* Notwithstanding, however, the apparent contraindications to 
the use of nitrous oxide in spotted fever, it may probably prove 
beneficial therein, more especially in the primary stage of de- 
pression to excite reaction, and during convalescence to promote 
recoverv. 



PROTOXIDE OF NITROGEN, ETC. 55 

These precautionary remarks are not, however, made 
with any disposition to undervalue this remarkable 
agent or excite undue apprehension respecting the 
potency of its action upon the economy, but simply 
with a view to afford a correct exposition of its anaes- 
thetic and other medical properties, for no one has a 
higher appreciation of its intrinsic merits and valuable 
sanitive effects than myself, yet it is proper that the 
truth should be known, to enable all to avoid the evil 
and obtain the good. 



IV. Preparation and Combinations of Nitrous Oxide. 

There are several methods of obtaining protoxide of 
nitrogen, which are well known to chemists, and de- 
scribed in the general works on chemistry, but perhaps 
the simplest and best plan is by the decomposition with 
heat of nitrate of ammonia. The necessary apparatus 
for its production and preservation consists of a gen- 
erator, purifier, and receiver, which should be of glass, 
or other non-oxidizable substance, though the first may 
be of iron, the second of wood or some metal pro- 
perly protected or capable of resisting the action of the 
agents employed, and the third of the same, or better 
still, of India-rubber or gutta-percha, where the gas is 
not required to be kept for any great length of time- 
The requisite heat may be obtained from various sources 
and be placed in direct or intermediate contact with the 



56 MEDICAL PROPERTIES AND APPLICATIONS OF 

retort. For the production of a moderate quantity of 
nitrous oxide a sufficiency will be furnished by an ordi- 
nary alcohol or other lamp with one or more large 
wicks, but for its free and rapid evolution it is better — 
as in fact it is in all cases— to apply the heat through 
the medium of a sand bath, which regulates and distri- 
butes the temperature so equably as to diminish the 
danger of injury to the apparatus or the production of 
contaminating substances, for if too suddenly or in- 
tensely applied it is apt to fracture or explode the re- 
tort, unless composed of some strong material like 
metal, as well as to cause the generation of noxious 
matters. 

Nitrate of ammonia is decomposed at a temperature 
of between 400° and 500° F., but if the heat be too 
great this salt will be volatilized and wasted, as will be 
indicated by the appearance of a white cloud instead of 
a colorless gas, or its decomposition will be attended by 
the formation of such objectionable compounds as nitric 
oxide and hyponitrous acid, either of which will, of 
course, necessitate the reduction of heat and careful 
purification. The retort should have a stopper, or be 
so connected with the purifier as to be readily separated 
therefrom, in order to speedily equalize the atmospheric 
pressure when the heat is undue or is withdrawn, and 
thus prevent destruction or flooding of the former by 
the forcible reflow of liquid from the latter. 

When pure, caeteris paribus, nitrate of ammonia is 



PROTOXIDE OF NITROGEN, ETC. 51 

resolved into protoxide of nitrogen and water, but as it 
is sometimes adulterated, besides the deleterious agents 
mentioned, other impurities may be given off, such as 
nitric acid and chlorine. For ordinary purposes nitrous 
oxide may be sufficiently freed from extraneous matter 
by passing it through water, with a large quantity of 
which, however, unless it is quite warm, it should not 
be allowed to remain long in contact if its economical 
preservation is of much moment, as this liquid will 
when cold absorb a volume of the gas nearly equal to 
its own bulk, though this may be readily recovered by 
simply heating the water. But as for medical purposes 
it is generally desirable to have protoxide of nitrogen 
quite free from contaminations, it is necessary to adopt 
such measures as will insure its purification, which may 
be effected in the following manner: The retort con- 
taining the nitrate of ammonia, should preferably be of 
glass, and be connected by means of glass or other 
tubes of non-oxidizable matter joined by cement, India- 
rubber, gutta-percha, or some similar substance, with 
three glass vessels, such as Wolf's bottles, conjoined in 
like manner. These last should be partially filled with 
the following fluids, viz., the first one with a saturate 
solution of protosulphate of iron, the second the same 
of caustic potash or soda, and the third with plain 
water. The connecting tubes, or those passing into 
the purifiers on the side toward the retort should be 
immersed into these respective liquids nearly to the 



58 MEDICAL PROPERTIES AND APPLICATIONS OF 

bottom of the vessel, but those on the side farthest 
therefrom should have their orifices above the liquid 
and close to the mouth of the bottle, which should be 
sufficiently capacious to admit of the insertion of a 
large stopper or cork containing the tabes of the 
greatest calibre that can be introduced. As nitrous 
oxide is generated it is compelled to thus pass through 
these different liquids which remove all adventitious 
matter and render it quite pure. This purified pro- 
toxide of nitrogen may then, as it comes over, be col- 
lected in suitable receivers, and be thus preserved for 
immediate use in its gaseous state, or, like carbonic 
acid, it may be introduced into some liquid which will 
take it up more or less freely, and for obvious reasons 
the fluid most convenient and useful for such purpose is 
water. Yet as water will not of itself absorb a suffi- 
ciently large quantity of nitrous oxide to render it very 
efficient for medical purposes, it is necessary to forcibly 
condense the gas therein, which should be continued 
until it is completely surcharged therewith, or to the 
extent at least of five volumes of the latter to one of 
the former, as it is not always desirable to administer 
much water, though frequently in this connection it 
offers no very serious objection, but, on the contrary, its 
free use is often therapeutically indicated, while at the 
same time it is always more or less essential as a di- 
luent. The relative proportion of these two compounds 
will therefore vary according to the special necessities 



PROTOXIDE OF NITROGEN, ETC. 59 

of the case, the degree of admixture depending upon 
the practical application, although the portability and 
eligibility of this preparation will be measurably in- 
creased by the maximum quantity of gas to the mini- 
mum of liquid. In view of the fact, however, that 
nitrous oxide gas will undergo liquefaction under a 
comparatively moderate pressure, it is highly probable 
that when thus forcibly introduced to any great extent 
into such fluids as water, it may be condensed into a 
liquid, and be mechanically associated if not chemically 
combined therewith, as these two bodies seem to have 
a strong affinity for each other, for I have known this 
nitrous oxide water kept in an ordinary bottle with a 
plain cork tied down, to preserve its active medicinal 
properties for the long period of about seven years. 
Protoxide of nitrogen may also be sometimes advanta- 
geously associated with alcoholic and other liquids for 
therapeutic purposes. But as the process for the sepa- 
rate liquefaction and solidification of nitrous oxide is 
being rapidly perfected, the necessity for the primary 
condensation with such fluids is diminishing ; still as 
the former is more difficult than the latter, and in con- 
sequence of the extremely important practical advant- 
ages of this agent for medical purposes, its ready ac- 
quisition is a great desideratum, it is hoped that both 
methods will be so fully adopted as to promptly furnish 
all that may be required. 



60 MEDICAL PROPERTIES AND APPLICATIONS OF 

V, Modes of Administration and Dose of Nitrons Oxide, 

Protoxide of nitrogen may be administered with ad- 
vantage either in its gaseons state by the lungs, or in 
association with liquids through this and other chan- 
nels. Thus for instance, it may be introduced within 
the body in the aeriform state, separately or in con- 
junction with aqueous and other vapors, by direct in- 
halation or artificial insufflation through the air-pas- 
sages, and in combination with water or other liquids 
through the alimentary canal by voluntary deglutition 
or the extraneous method of injection into the stomach 
and rectum. Also to some extent through the cutane- 
ous surface. Either one or more of these modes of 
administration may be resorted to advantageously, ac- 
cording to the necessities of the particular condition 
requiring treatment, though in states of unconscious- 
ness, and inability to inspire or swallow, as well as in 
cases of obstinate refusal to otherwise take it when 
needful, the artificial introduction of this agent may 
be the only alternative. 

The effects of nitrous oxide, both in the form of gas 
by the pulmonary organs and in connection with liquids 
by the alimentary canal, are in general the same, though 
in the latter state and mode of exhibition, it sometimes 
seems to exert a more immediate and specific influence 
upon the chylopoietic viscera and genito-urinary organs, 
than when taken in the gaseous condition through the 



PROTOXIDE OF NITROGEN, ETC. 61 

air-passages. In depressed cases, as of asphyxiation, 
suspended animation, or intoxication from various poi- 
sons, even when so profound as to temporarily place in 
abeyance the functions of deglutition, respiration, cir- 
culation, and innervation, the surcharged nitrous oxide 
water, and doubtless also other liquid preparations, may 
be injected into the bowels with such decided benefit as 
to sometimes induce speedy recovery, and always, so far 
as my experience goes, with a certain degree of ad- 
vantage. Nitrous oxide may likewise be frequently 
administered with benefit in conjunction with wine and 
other alcoholic fluids. 

This oxygenated liquid is a very convenient and 
valuable preparation, as it favors the more general dis- 
tribution and application of its active ingredient, pro- 
toxide of nitrogen. When well made, nitrous oxide 
water is rather lively and sparkling, having a somewhat 
sweetish insipid taste, but with the addition of aromatic 
or other agreeable compatible substances it forms quite 
a palatable beverage. In view of this fact and the 
peculiarly pleasant as well as invigorant action of pro- 
toxide of nitrogen, this aqueous preparation will no 
doubt prove a valuable substitute for the various alco- 
holic and other objectionable compounds so freely em- 
ployed for stimulating purposes. Hence in this con- 
nection, nitrous oxide water is of especial interest, as it 
will have a tendency to diminish the use of intoxicating 
liquors and the evils connected therewith. This oxy- 

6 



62 MEDICAL PROPERTIES AND APPLICATIONS OF 

genated liquid will doubtless thus prove extremely 
useful in substituting a decidedly agreeable and highly 
sanitive for a positively injurious and destructive agent, 
as it will frequently promptly allay thirst and effectually 
satisfy the craving for some stimulus, without like alco- 
hol either poisoning the body, stupefying the mind, or 
degrading the nature of those who use it. As before 
indicated, however, the salutary effects of nitrous oxide 
are not exclusively limited to the preceding, being more- 
over powerfully antagonistic to the deleterious effects 
of such agents, and thus quite active in the opposite 
direction, with perhaps one exception, for when taken 
too freely it is apt to unduly excite the sexual appetite, 
and thus indirectly encourage vicious practices, though 
even in this respect it is less obnoxious than alcoholic 
liquors, for unlike them it does not infuriate the pas- 
sions and at the same time deaden the moral sensibili- 
ties, but while increasing erotic desire, also intensifies 
physical and mental energy, thereby augmenting in- 
stead of diminishing the power of resistance to immoral 
courses. 

The dose of protoxide of nitrogen necessarily de- 
pends upon the varied circumstances of race, age, sex, 
constitution, temperament, idiosyncrasy, and special 
application, as well as the type, stage, intensity, and 
complications of the particular disorder requiring 
treatment. Thus, for instance, as a general rule, per- 
sons of a lymphatic can bear larger quantities than 



PROTOXIDE OF NITROGEN, ETC. 63 

those of a sanguine or bilious temperament; and these 
latter more than the nervous, — these being frequently 
very susceptible to its excitant influence. Besides, as 
with most other agents, males will usually require more 
than females, adults than youths, and these again more 
than children. Hence, the quantity of nitrous oxide gas 
which may be exhibited at any one time, will vary from a 
very small to a comparatively large volume; as, for ex- 
ample, from one pint or less to several gallons, according 
to special indications and capacities ; while that of the 
surcharged water ranges from one fluid drachm to one- 
half pint or more, repeated as often as may be necessary 
to produce the desired effect. The best plan, in ordi- 
nary cases, is to commence with a minimum, or what 
appears to be a suitable quantity for the case under 
treatment, and gradually or rapidly increase, until its 
action is manifest, or the required result is obtained, 
and continue according to circumstances, unless in con- 
ditions of extreme danger, when it may be freely em- 
ployed without hesitation ; for the necessity for stimulus 
is at such times generally so great, and the tolerance 
usually so much increased, as to render any appre- 
hended evil from a liberal use of minor importance. 

For the production of anaesthesia, however, some risk 
must always be run, as a comparatively large quantity 
will be required to be quickly administered; usually 
from two to four or more gallons of the gas, which 
should be repeated or its inhalation continued at short 



64 MEDICAL PROPERTIES AND APPLICATIONS OF 

intervals, when a somewhat prolonged anaesthetic con- 
dition is required. 

In thus enforcing the necessity for care in the use of 
nitrous oxide, it is not intended to excite undue appre- 
hension respecting its dangerous tendencies, but merely 
to guard against overweening confidence in its harm- 
lessness; for, though ordinarily quite safe, it is yet 
sufficiently potent to do great injury to the vital econ- 
omy, even to the speedy destruction of life. Hence, 
under no circumstances should such an active agent be 
carelessly exhibited; for while in general the influence 
of protoxide of nitrogen is very agreeable, invigorating, 
and innoxious, yet, as it is powerfully stimulant with, 
as before mentioned, a special tendency to the blood, 
brain, nervous, vascular, and nutritive systems, as well 
as to the genito urinary organs, its indiscriminate and 
disproportionate employment is to be avoided, as it 
may prove injurious by superoxidation, overstimula- 
tion, and otherwise in the manner previously indicated. 

Moreover, besides the immediate evils which may 
thus result from the rapid exhibition of a large quantity 
of nitrous oxide, there are others which follow its pro- 
longed and inordinate use. Thus, if taken too freely 
for any length of time, it will cause undue molecular 
metamorphosis, with excessive disintegration of struc- 
ture and emaciation of body, with abnormal excitability 
of kidneys, bowels, brain, and nervous system, unat- 
tended, however, unless in extreme cases, with any 



PROTOXIDE OF NITROGEN, ETC. 65 



direct manifestation of weakness or debility, but rather 
with a restless energy, tending to vital exhaustion, from 
the superabundant consumption of the material ele- 
ments and dynamic power of the organism. Neverthe- 
less, though ordinarily thus objectionable in immoderate 
quantities, yet, when used discriminately, even to the 
extent of causing somewhat extreme disintegration of 
tissue and superexcitability, this agent will not usually 
produce so much waste or irritability of system as to 
prove injurious, but on the contrary by increasing the 
activity and augmenting the power of molecular and 
somatic life, be often very efficient in improving the 
tone of both body and mind. Hence, as before stated, 
in those cases of obesity, and other forms of abnormal 
nutrition, as well as in the many aberrations of function 
in which modified metamorphosis and increased disin- 
tegration with general invigoration is required, nitrous 
oxide offers, cseteris paribus, the most reliable jneans 
for the purpose, as it will not only reduce redundancy 
of flesh and regulate organic action, but will increase 
dynamization, and promote thereby the health and 
strength of the entire economy, both corporeally and 
psychically. 

With regard to any absence of detail, or deficiency of 
cases in illustration of the correctness of the foregoing 
observations, it is proper to state, in conclusion, that in 
this paper I have mainly endeavored to give a very 



66 PROPERTIES, ETC. OF PROTOXIDE OF NITROGEN. 



general outline of the chemical constitution and prop- 
erties, physiological influences, and modes of prepara- 
tion, combination, and administration of protoxide of 
nitrogen, and to point out some of its principal hy- 
gienic, therapeutic, revivifying, antidotal, and anaesthetic 
applications, hoping at a future time to be able to 
communicate more fully on the subject. Hence, not- 
withstanding the preceding remarks might be greatly 
extended, I believe I have presented enough to exhibit 
the superior sanitive power of nitrous oxide and demon- 
strate its great practical value in the support of life 
action. In consequence, therefore, of its pre-eminent 
importance to the medical profession and humanity at 
large, it is hoped these general observations will attract 
the favorable attention of scientists to the transcendant 
merits of this remarkable agent, and thereby aid in ex- 
tending its application for the preservation of life, 
diminiition of suffering, and the promotion of health 
and happiness. 



' 



